P. 1
“Acute Coronary Syndrome Non ST Elevation Myocardial Infarction, Hypertensive Cardiovascular Disease, Diabetes Mellitus Type 2, and Community Acquired Pneumonia” Client Centered Pathophysiology

“Acute Coronary Syndrome Non ST Elevation Myocardial Infarction, Hypertensive Cardiovascular Disease, Diabetes Mellitus Type 2, and Community Acquired Pneumonia” Client Centered Pathophysiology

|Views: 757|Likes:
Published by caloi

More info:

Published by: caloi on May 01, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less

05/12/2014

pdf

text

original

c) Schematic Diagram (client – based

)
Non – modifiable Risk Factors: -68 y/o and above -Familial history of DM type 2 - Pacific Islander -Familial history of hypertension Modifiable Risk Factors: -Sedentary lifestyle -Previously known Impaired - Emotional Stress Fasting glucose -↑consumption of fatty, salty & sweet food

Insulin resistance and desensitization
↑Insulin demand Β cell exhaustion

11-26-09 FBS= 192.91mg/dl HGT 11-25-09 309mg/dl, 159mg/dl 11-26-09 179,148,156 mg/dl 11-28-09 153, 140mg/dl

↓insulin production

↑glucagon Release

Fats and Proteins breaks down to glucose

↑blood glucose level

Impaired glucose absorption

Cellular starvation

Activation of satiety center

Easy fatigability Complaint on his check up 5 years ago.

↑osmolality
Chronic glucose elevation HbA1c 11-25-09 10.9%

Polyphagia As verbalized by the patient, started 5 years ago until prior to admission

Fluid shifts from IC to IV
Cellular dehydration Thirst center activation

↑ Blood viscosity
Glycoprotein cell wall deposits

↑blood volume ↑GFR
Polyuria
As verbalized by the patient, started 5 years ago until prior to admission

Sluggish blood flow

Narrowing of blood vessel

Polydipsia
As verbalized by the patient, started 5 years ago until prior to admission

blood vessel occlusion

↓ perfusion

Small vessel disease Diabetic retinopath y Blurring of vision Eyeglass power of L- 250 R- 240 Hypertension
130 – 150/ 70 -90 mmHg as verbalized by his daughter (usual BP prior to admission) 11-25-09 190/130 mmHg

Accelerated atherosclerosis

↑LDL June 27, 2009 187 g/dl Coronary Artery Disease

Plaque rupture

Exposure of subendothelial matrix

Platelet activation

Change in platelet shape

Platelet degranulation

↑ Expression of Platelet GP IIb/IIIa

Platelet adhesion to subendothelial matrix

Release of Thromboxane A2, Serotonin and other platelet aggregatory agent

Enhanced affinity to fibrinogen

Platelet aggregation

↓ Arterial lumen

Plasma Coagulation System activation

Formation of thrombin

Converts fibrinogen to fibrin

Enhances platelet aggregation

Stabilization of fibrin clot

Fatigu

Productive Adventitious cough ↓ Breath DOB

Pulmonar y

Backflow Impaired of blood repolarization in the the ofAngina Lactic acid Anaerobic ECG

Blood pooling ↓ Irregular Release of Myocardi lysosomalImpaired ↓ cell al onIschemiaMyocardial ↓cardiac by ↑BP, HR, and O2heart left Vasospasm cardiac ventricular ↑ of the tissue supplied Coronary dislodges vasocontricti SNS

Nidus of rethrombosis

Re-establishment of the endothelium with fibrotic
Hardening of the coronary arteries

Vasospasm dislodges thrombus

Coronary occlusion

Impaired cardiac perfusion

Anaerobic glycolysis

Ischemia of the tissue supplied by the artery

Angina 11-25-09

Lactic acid production

Myocardial cell death

↓ Serum Mg level 11-25-09

Impaired repolarization of the myocardium

Release of lysosomal enzymes

Adventitious Breath sounds Crackles 11/25-30/09

ECG changes
ST Depression (11/25/09 9:00pm)

↑ CKMB
11/25/09 47.4 mg/dL

↓cardiac contractility 2D – echo 11-27-09 thinned out akinetic entire interventricular septum from mid to apex, severe hypokinesia of all left ventricular segments ↓ ventricular function 2D echo 11-27-09 left ventricular systolic function is severely depressed

Myocardial irritability

Irregular heart beats Afib RVR (11/25/09 9:30pm)

Productive cough 11/25-30/09

Fatigue
11/2528/09

↓ oxygenation

Pulmonary congestion CXR result 11/25/09

Backflow of blood in the lungs

Blood pooling on left ventricle

DOB 11/25-28/09 2 LPM O2 supplementation

↓ CO 2d echo 11-27-09 calculated ejection fraction of 34% by cube method and 25 +/25% by visual estimated method

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->